Loy See Mey1
Rozainee Khairudin2
Tengku Elmi Azlina Tengku Muda3
Hilwa Abdullah @ Mohd Nor2
Mohammad Rahim Kamaluddin2*
- 1Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- 2Faculty of Social Sciences and Humanities, Centre for Research in Psychology and Human Well-Being, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- 3PERMATApintar National Center, Universiti Kebangsaan Malaysia, Bangi, Malaysia
Studies have reported high rates of childhood maltreatment among individuals with drug addiction problems; however, investigation about the potentially protective factors to mitigate the effects of maltreatment experiences on motivation to engage in addiction treatment has received less attention. This study aims at exploring the mediating effects of forgiveness and self-efficacy on the association between childhood maltreatment and treatment motivation among drug addicts. A total of 360 male drug addicts (mean age = 33.34, SD = 7.25) were recruited from three mandatory inpatient rehabilitation centers in Malaysia. Participants completed a package of self-report questionnaires including measures of childhood maltreatment experiences, forgiveness, self-efficacy, and motivation for treatment. The analysis conducted using the structural equation model (SEM) revealed that childhood maltreatment significantly predicted lower treatment motivation, while forgiveness and self-efficacy played a fully mediating role regarding the effect of childhood maltreatment on treatment motivation. In conclusion, these findings suggest that combining the element of forgiveness and self-efficacy in treatment programs appears to benefit the drug addicts with childhood maltreatment history.
Introduction
Exposure to maltreatment during childhood has long been associated with an increased risk of subsequent psychological and behavioral problems across the human lifespan including mood disorders (Norman et al., 2012; Lippard and Nemeroff, 2020), depression (Dhamayanti et al., 2020), post-traumatic stress disorder (McLaughlin et al., 2017; Schuck and Widom, 2019), borderline personality disorder (Mainali et al., 2020), adult criminality (Minh et al., 2013; Kim et al., 2016), and drug and substance abuse (Elwyn and Smith, 2013; Mandavia et al., 2016). Studies have demonstrated that maltreatment histories are relatively common among individuals receiving treatment for substance and drug abuse (Funk et al., 2003; Banducci et al., 2014; Loy et al., 2020a). However, most studies on the effects of childhood maltreatment among drug addicts are often focused on behavioral consequences and psychological risk factors associated with maltreatment, yet less is known about how the experience of maltreatment in the early stage impacts the motivation among drug addicts entering substance abuse treatment, which can be considered as a significant factor to influence the treatment outcomes and service provision.
Furthermore, studies indicated that not all children with maltreatment experience grow up to abuse drugs or substances (Simpson and Miller, 2002). Therefore, the mechanism regarding the pathways between childhood maltreatment and subsequent addiction, which might influence the later treatment engagement to abstain from drug use, remains unclear. Moreover, in Malaysia, various efforts have been made by the government to combat illicit drugs over the past decades; however, the continued failure of the war on drugs with increasing number of drug addicts being reported each year and high relapse rate following treatment has aroused controversies surrounding the effectiveness of government agencies and local leaders in addressing the country’s drug addiction problem. Therefore, examining the etiologies, such as early maltreatment history that might explain the onset of drug use, would be essential for refining the existing treatment program that lacks tackling the issue of adverse experience, particularly for drug addicts who have experienced adversity in early life. In short, interventions that can provide support to drug addicts’ unresolved childhood issues might help to increase their motivation to remain in treatment and further reduce their risk of relapse and improve their adaptive functioning after discharge from the rehabilitation center.
Rehabilitation programs are essential for recovery among drug addicts. However, research indicated that a high number of drug addicts receiving treatment failed to stay throughout the rehabilitation programs or experienced relapse due to adverse effects such as anxiety, anger, shame, and guilt (McKay, 2011; McGaffin et al., 2013; Serafini et al., 2016). Moreover, several studies have pointed out the use of the drug as a coping mechanism to eliminate the overwhelming negative emotions in drug addicts (Baker et al., 2004; Webb et al., 2006; Blevins et al., 2014). In view of the association between drug abuse, negative emotions, and treatment failure; forgiveness, which was well supported by literature to demonstrate a significant relationship with mental wellbeing and positive emotional states (Ricciardi et al., 2013; Raj et al., 2016; Toussaint et al., 2016; Long et al., 2020), has been hypothesized and proven to play a role in addiction and recovery (Worthington et al., 2006; Scherer et al., 2011).
Although the definition of forgiveness varied by the scholars who defined it, however, most definitions agreed that forgiveness refers to a decrease in negative feelings, thoughts, and behaviors while being able to cultivate positive or neutral emotions toward the wrongdoer (Enright, 1996; Maynard et al., 2016; Worthington et al., 2016). In relation to the context of trauma, a higher level of childhood maltreatment was often associated with a lower level of forgiveness (Guloglu et al., 2016; Arslan, 2017). Moreover, studies indicated that individuals who have experienced negative life events at an early age are predisposed to develop more maladaptive thoughts and behavioral dysfunction, which might impede their coping skills and strategies later in life (Pears and Fisher, 2005; Kim and Cicchetti, 2010; Milojevich et al., 2018). Furthermore, it seems reasonable to expect that drug use would be the most convenient option for someone with poor coping skills to deal with negative emotions. Therefore, in view of the positive effects shown by forgiveness, this element can be considered as an effective coping strategy to buffer against the negative impacts of traumatic experience, to improve the mental wellbeing (e.g., anger, guilt, and depression), and, finally, to improve the drug treatment outcomes. In other words, forgiveness could be a positive coping mechanism in lieu of drugs.
The concept of self-efficacy, which originated from Bandura’s Social Learning Theory, referred to a person’s beliefs in their capacity to use resources and skills to accomplish certain tasks (Bandura, 1993). In the context of drug abuse, abstinence self-efficacy, which is considered as a specific form of self-efficacy to examine the ability among drug addicts to abstain from drug use, has been identified as a significant intrapersonal resource to predict substance use (McKay et al., 2004; Majer et al., 2016) and also as a crucial component to improve drug treatment outcomes (Litt et al., 2008; Kadden and Litt, 2011) and future abstinence (Chavarria et al., 2012). However, in drug treatment research, an area in which knowledge is currently lacking is the association between drug addicts’ motivation when entering drug treatment in relation to their level of self-efficacy. Moreover, existing research in this area has tended to focus on abstinence self-efficacy (Kelly and Greene, 2014; Majer et al., 2015) rather than to explore the role of general self-efficacy which covers the overall beliefs in drug addict’s ability to succeed in treatment.
Studies have indicated that self-efficacy played a role as an effective predictor of children’s subsequent development (Bandura, 1993; Tsang et al., 2012). Moreover, in the context of child abuse, childhood maltreatment is associated with lower self-efficacy and various health problems in adulthood (Sachs-Ericsson et al., 2011; Taylor et al., 2016; Basu et al., 2017). According to the attachment theory, childhood maltreatment negatively affects the formation of secure attachments among children which later poses a challenge to the development of self-efficacy beliefs throughout their lives (Riggs, 2010) which, in turn, can affect one’s self-regulation of motivation to accomplish something later in life (Tsang et al., 2012). In short, the adverse experience in the early years can negatively impact the cognitions about the self and the control one can exert over his or her own functioning.
Significantly, the evidence of individuals’ differences in negative outcomes, such as the development of drug use problems in response to childhood maltreatment, implies an indirect pathway between the relationship of maltreatment experience and drug addiction (Simpson and Miller, 2002; Rutter, 2007; Wahab et al., 2021). In other words, other factors may play a role in explaining the mechanism underlying this relationship. In addition, in view of the inconsistent findings reported by previous studies between the association of maltreatment experience and drug treatment motivation (Battjes et al., 2003; Rosenkranz et al., 2012; Lu et al., 2017), the purpose of this study was to examine the relationship between childhood maltreatment and motivation among drug addicts entering treatment and the factors that have the potential to explain the relationship between the two variables.
In view of the impacts of childhood maltreatment on the formation of forgiveness and self-efficacy and the significant role as coping strategy played by both factors (Witvliet and McCullough, 2007; Cieslak et al., 2008), this study hypothesized that the association between childhood maltreatment and treatment motivation among drug addicts would be mediated by individual differences in forgiveness and self-efficacy, with higher levels of forgiveness and self-efficacy predicting higher levels of motivation in treatment. In addition, there is evidence that different types of childhood maltreatment experiences may yield specific pathways to the development of negative outcomes (Infurna et al., 2016). Thus, this study further examined the predictive value of different forms of childhood maltreatment, which included emotional, physical, sexual abuses, and emotional and physical neglect on motivation as well as its association with forgiveness and self-efficacy.
Materials and Methods
Participants and Procedure
The study protocol was approved by the National Anti-Drugs Agency (AADK) of Malaysia. All participants were recruited from three mandatory drug rehabilitation centers managed by AADK that comes under the supervision of the Malaysia Home Ministry that provides free treatment and rehabilitation programs to the individual who has been confirmed as a drug addict. First, a pilot study was conducted by recruiting 160 inpatient drug addicts from a drug rehabilitation center, where 144 questionnaires were completed and used for the analysis. Next, in view of the gender ratio of drug addicts which was close to 40 males per 1 female in Malaysia according to the statistics provided by AADK, a total of 380 male inpatient drug addicts entering substance abuse treatment were selected through a simple random sampling. However, after excluding the poorly completed questionnaires and missing data, 360 samples remained to use for the analysis. A briefing session regarding the ethical measures and research objectives was conducted at the beginning, and informed consent was requested from each participant to use the information for research purposes. The average age of the sample was 33.34 years (SD = 7.25), and participants were predominately Malay (96.4%) and single (53.1%). All participants have gone through evaluations and assessments and were diagnosed with substance use disorder (SUD) by psychiatrists and narcotic officers under AADK before they were admitted to the rehabilitation centers to receive treatment. In addition, several different drugs were reported by the participants throughout their drug use histories which encompassed opioids, ecstasy, amphetamines, cocaine, marijuana, and other types of psychotropic drugs. All recruited participants were with reading and comprehension abilities to take part in the research.
Measures
Childhood Maltreatment
Childhood maltreatment was examined using the 28 items of the Childhood Trauma Questionnaire Short Form (CTQ-SF). CTQ-SF is a retrospective self-administered screening device used to detect histories of childhood abuse and neglect. It is the most commonly used and valid assessment tool to enable the identification of five dimensions of childhood maltreatment experiences, namely, emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN) (Bernstein et al., 2003). The original version of CTQ-SF has shown sufficient psychometric properties across different settings (Bernstein and Fink, 1998; Gerdner and Allgulander, 2009). Meanwhile, the Malay version of CTQ-SF (M-CTQ-SF), which exhibited good performance in reliability and validity, and cultural equivalence in the Malaysian population, was used in this study (Loy et al., 2020b). Participants were asked to report the frequency of their maltreatment experience during their first 16 years of life by using a 5-point Likert-type response, ranging from 1 = never to 5 = very often. Items are generally phrased in a non-evaluative manner, given as follows: “People in my family said hurtful or insulting things to me” for emotional abuse and “My family was a source of strength and support” for emotional neglect. Overall, the raw and total scores of CTQ-SF examine the separate and combined effects of multiple forms of childhood abuse and neglect experiences. The Cronbach’s alpha coefficient of the total M-CTQ-SF was 0.88, while the alpha coefficient for the five subscales ranged from 0.61 for sexual abuse to 0.81 for emotional abuse in the current sample.
Motivation in Treatment
The Circumstances, Motivation, and Readiness (CMR) Scales were used to examine the drug addicts’ motivation in treatment. The CMR is a self-report measure with 18 items scoring on a 5-point Likert-type response ranging from 1 = strongly disagree to 5 = strongly agree. The subscale of Circumstances refers to the external factors that influence an individual to seek treatment, the Motivation subscale refers to an individual’s inner factors for change, whereas the Readiness subscale assesses an individual’s perceived need for treatment in order to change (De Leon et al., 1994). Besides, potential total scores for CMR range from 0 to 90 with higher scores indicating higher motivation and readiness for treatment. Overall, CMR demonstrated adequate total score reliability with Cronbach’s alpha coefficient ranging from 0.70 to 0.80 across a wide variety of substance-using populations (De Leon et al., 2000; Melnick et al., 2014). Meanwhile, the Cronbach’s alpha of the total scores of CMR was 0.843 in this sample.
Forgiveness
The Heartland Forgiveness Scale (HFS) was used to measure an individual’s dispositional forgiveness of themselves, others, and situations. The HFS is an 18-item self-report measure scoring on a 7-point Likert-type response ranging from 1 = almost always false of me to 7 = almost always true of me. Participants were asked to report their typical responses to the negative events which occur due to their own actions (e.g., “I hold grudges against myself for negative things I’ve done”), the actions of others (e.g., “I continue to be hard on others who have hurt me”), or circumstances out of their control (e.g., “It’s really hard for me to accept negative situations that aren’t anybody’s fault”). Besides, total HFS scores range from 18 to 126 with higher scores indicating higher levels of forgiveness. Previous research reported adequate psychometric properties with Cronbach’s alpha coefficient ranging from 0.86 to 0.87 for the total HFS, while 0.72–0.82 for the subscales (Thompson et al., 2005). In this sample, the Cronbach’s alpha of HFS was 0.825.
Self-Efficacy
The General Self-Efficacy Scale (GSES) is a 10-item self-report measure that was used to assess an overall sense of self-belief in coping with various difficult demands in life (Schwarzer and Jerusalem, 1995). A sample item included: “It is easy for me to stick to my aims and accomplish my goals.” Participants were asked to rate their agreement on each item on a 4-point Likert-type response ranging from 1 = not at all true to 4 = always true. The GSES sum score ranges from 10 to 40 with higher scores indicating greater self-efficacy. Besides, this scale has been shown valid and reliable in numerous studies, with good internal consistency ranging from 0.75 to 0.94 (Schwarzer et al., 1997; Luszczynska et al., 2005); meanwhile, the Cronbach’s alpha coefficient of GSES in this sample was 0.908.
Statistical Analysis
Overall, several data analyses were conducted to examine the associations between childhood maltreatment, treatment motivation, forgiveness, and self-efficacy. First, the exploratory factor analysis (EFA) was carried out via IBM-SPSS 22 using the data from the pilot study to explore the usefulness of items that measure the respective constructs being studied. Certain items with poor factor loading were being removed based on the EFA results (McNeish, 2017). Thereafter, in order to investigate the validity of the model, 360 sets of field data (collected via the final version of questionnaires which is being constructed using the results of EFA) were used to conduct the confirmatory factor analysis (CFA) using IBM-SPSS AMOS 22. Following CFA, associations between the variables were examined with the scores of the variables being standardized into z-values. Furthermore, the structural equation modeling (SEM) was performed to examine the interrelationships among the constructs in this study. Finally, the mediation effects of forgiveness and self-efficacy were assessed using 5,000 bootstrapped samples with a 95% CI.
Results
Validity and Reliability
Prior to performing the SEM for hypothesis testing, CFA was conducted to examine the construct validity, convergent validity, and discriminant validity of all constructs that were being researched in this study (Hair et al., 2006). The three constructs, namely, childhood maltreatment, forgiveness, and treatment motivation, being studied were second-order constructs with complicated measurement model; therefore, the CFA for each measurement model was assessed separately, and all models were combined to perform a pooled-CFA after all constructs achieved the respective thresholds of validity and reliability in individual assessment (Awang et al., 2018). The results of individual CFA assessment for all constructs were presented in Supplementary Appendix.
Thereafter, in pooled-CFA assessment, all second-order constructs that have been validated were simplified into first-order constructs. First, the construct validity was assessed by looking at the fitness indexes of the model. According to the CFA outputs, as presented in Figure 1, the fitness indexes have achieved the requirement of construct validity with the absolute fit (RMSEA = 0.073) less than 0.08 and the parsimony fit index (chi2/df = 2.930) below 5, while all the other indices (e.g., GFI, CFI, IFI, NFI, TLI) were higher than 0.9 (Awang et al., 2018). Moreover, the factor loadings for all items were above 0.6, which indicated the unidimensionality of the model (Byrne, 2016) except for SA and PN with factor loadings below the cutoff point. However, the two items were retained due to the suggestion that factor loading above 0.4 in CTQ-SF was acceptable (Bernstein et al., 1994).
Figure 1. The Results of Confirmatory Factor Analysis (CFA).
The average variance extracted (AVE), which determines the convergent validity, and CR, which determines the composite reliability for all latent constructs, are presented in Table 1. Because the values for both AVE and CR were computed using the factor loadings, the AVE for the construct of childhood maltreatment was unsatisfactory (0.45), while the AVE for other latent constructs was above 0.5, which indicated a high convergent validity (Byrne, 2016). However, since the composite reliability of childhood maltreatment was above 0.6, its convergent validity is still considered adequate (Fornell and Larcker, 1981). Besides, concerning the discriminant validity, AVE for each latent construct in the model was greater than its respective square root of correlation value with other constructs as presented in Table 1 (AVE > r2); thus, the discriminant validity of all latent constructs was accomplished (Byrne, 2010). Furthermore, the correlation value (r) between self-efficacy with its respective constructs was all below 0.85, which indicated that the model was free from the multicollinearity problem. Therefore, it can be concluded that the construct validity, convergent validity, and discriminant validity of all constructs in this study have been achieved.
Table 1. Discriminant validity index summary.
Relationship Analysis
Findings from preliminary analysis demonstrated that all variables in this sample have adequate internal reliability, ranging from 0.80 to 0.89. Thereafter, Pearson correlation was conducted in exploring the relationship among childhood maltreatment, forgiveness, self-efficacy, and treatment motivation. Childhood maltreatment was negatively correlated with treatment motivation (r = 0.562, p < 0.01), forgiveness (r = –0.638, p < 0.01), and self-efficacy (r = –0.612, p < 0.01). In addition, treatment motivation indicated a positive relationship with forgiveness (r = 0.810, p < 0.01) and self-efficacy (r = 0.812, p < 0.01). Furthermore, the inter-correlations between the total score of CTQ-SF with the five maltreatment subscales were found to be significant. Among the five subscales, EN and SA indicated the highest and lowest correlations with the total CTQ-SF, respectively (Table 2).
Table 2. Descriptive statistics and correlation results of variables.
Model Analysis
After all the constructs have been validated, SEM was followed to test the interrelationships among the constructs in the model. Overall, the results of the regression path coefficient (β) which reflected the predictive effects of exogenous constructs on the endogenous constructs were presented in Figure 2 with the interpretation in Table 3. Childhood maltreatment was a negative predictor of forgiveness (β = –0.861, p < 0.001) and self-efficacy (β = –0.831, p < 0.001), yet it did not significantly predict treatment motivation (β = –0.178, p = 0.678) in the mediation model. Therefore, the association between childhood maltreatment, forgiveness, and treatment motivation was continued to assess in the direct model. Moreover, treatment motivation was significantly predicted by forgiveness (β = 0.740, p < 0.001) and self-efficacy (β = 0.373, p < 0.032).
Figure 2. The standardized regression path coefficient between constructs. ***p ≤ 0.001, **p ≤ 0.05.
Table 3. The regression path coefficient.
Mediating Analysis
In order to examine whether forgiveness plays a mediator role between childhood maltreatment and treatment motivation, the bootstrap procedure involving both the mediation model and direct model was utilized. Results from these two models were used to assess for the mediation effect of forgiveness (Table 4). In the direct model, all the indirect paths were constrained to zero in order to eliminate the mediator effect in the model (Figure 3). As a result, without the interference of the mediator, treatment motivation was significantly predicted by childhood maltreatment (β = –0.678 p < 0.001). Taken together, these results supported the predictive role of childhood maltreatment in treatment motivation via forgiveness and self-efficacy, with forgiveness and self-efficacy fully mediating this association.
Table 4. Results of the direct model.
Figure 3. The direct model. ***p ≤ 0.001.
The Effects of Different Forms of Childhood Maltreatment
Overall, this study aimed to examine the association between childhood maltreatment and treatment motivation among drug addicts; thus, besides investigating the overall effects of childhood maltreatment as an individual variable on its endogenous constructs, the predictive value of various forms of maltreatment from the overall maltreatment in the model was further assessed to attain a more holistic data. As presented in Figure 4, the outcomes produced by SEM were consistent with the previous results when replacing the total scores of maltreatment with different forms of maltreatment. In other words, four forms of maltreatment, namely, EA, PA, SA, and EN, were significantly related to forgiveness and self-efficacy, and they played a predictive role in treatment motivation in the direct model (Table 5). These results further suggested that a strong association exists between the various forms of maltreatment with forgiveness and treatment motivation among drug addicts. Furthermore, it also supported the full mediating role of forgiveness in the relationship between various forms of maltreatment and treatment motivation.
Figure 4. The direct model of various forms of maltreatment. All indirect paths constrained to 0.
Table 5. Results of mediation effect of forgiveness and self-efficacy on various forms of maltreatment and treatment motivation.
Discussion
Child maltreatment that included various forms of abuse and neglect is a significant social problem that affects all races, ethnicities, and socioeconomic groups with severe lifelong consequences. Research has highlighted the link between childhood maltreatment and later engagement in high-risk behaviors, such as substance and drug abuse (Mandavia et al., 2016; Yen et al., 2021; Lim et al., 2021), followed by different kinds of mental difficulties that pose threat to the motivation of abstaining from addictive behaviors (Grella and Joshi, 2003; Rosenkranz et al., 2012). Therefore, this study aimed to alleviate the negative impacts of childhood maltreatment on motivation to engage in treatment programs among drug addicts. To this end, this study examined the potential variables that were deemed effective in reducing the negative emotions resulting from past adverse experiences in a healthy way. Furthermore, both forgiveness and self-efficacy, which were considered as positive elements with a strong association with resilience (Srivastava, 2011; Kelly, 2018; Bikar et al., 2021), have been investigated for their mediating effects on the association between childhood maltreatment and treatment motivation in drug addicts.
Overall, the results of this study were consistent with previous research that demonstrated a significant association between childhood maltreatment and treatment motivation among drug addicts undergoing inpatient treatment programs. The negative association between both overall childhood maltreatment and different forms of maltreatment with treatment motivation supported and extended the previous research that the childhood adverse personal histories could undermine the treatment engagement and recovery process (Sacks et al., 2008; Lu et al., 2017). Moreover, the present results implied the role of a drug as an unhealthy alternative for the addicts with adverse histories to escape from pain and emotional distress. Previous research has indicated the myriad challenges encountered by addicts with histories of abuse in drug treatment including negative psychological functioning (Sacks et al., 2008) and greater severity of anxiety that co-occurred with strong feelings of shame, anger, and self-blame (Bennett et al., 2005; Rosenkranz et al., 2012), which could pose formidable threats to their willingness to abstain from drug use. Furthermore, the findings of Grella and Joshi (2003) indicated that a more intensive level of care in treatment required by drug addicts with histories of abuse also implied the negative impacts of childhood maltreatment on treatment motivation.
Moreover, findings from this study indicated that childhood maltreatment is a significant predictor of forgiveness, consistent with previous studies that reported a negative association between maltreatment histories and forgiveness (Snyder and Heinze, 2005; Arslan, 2017). Various negative outcomes on physical and mental health are well documented for those who experience childhood maltreatment (Currie and Widom, 2010; Norman et al., 2012; Tharshini et al., 2021), thereby potentially affecting their social functioning, such as lack of engagement and support from families in the growing up process (Lamis et al., 2014). Moreover, Müller et al. (2019) demonstrated the negative impacts of poor social functioning as a result of childhood maltreatment, which includes difficulties making connecting relationships and insensitivity toward others, which may thereby affect their development of forgiveness (Müller et al., 2019). Furthermore, considering the nature of abusive families, maltreated children were prone to believe that they cannot rely on others for care and support, which may later develop an insecure attachment style (Ainsworth, 1989). Research indicated that individuals with insecure attachment have more difficulty repairing the relationship after an offense occurs (McCullough et al., 1998) and as well demonstrated a lower level of forgiveness (Burnette et al., 2009). To sum up the literature, an individual’s forgiveness may indirectly be affected by childhood maltreatment experiences, and it seems logical to expect that individuals with maltreatment histories might face various challenges in the development of forgiveness, supported by findings from this study.
First, the indirect effect analysis demonstrated the full mediation effect of forgiveness in the relationship between childhood maltreatment and treatment motivation. In other words, the results supported the role of forgiveness as a mitigating factor in alleviating the effect of childhood maltreatment on treatment motivation among drug addicts. Thus, forgiveness might be an effective element in helping drug addicts in the face of childhood adverse experiences. Research has indicated that childhood maltreatment was the predictor of shame proneness, and drug use may work as the mechanism to cope with negative emotions (O’Connor et al., 1994; Rahim and Patton, 2015). Besides, previous studies have demonstrated higher levels of anger among drug addicts (Lin et al., 2004), which may function as a defense mechanism against the feeling of shame and guilt associated with their addiction behavior (Worthington et al., 2006). Thus, it seems reasonable to expect a cyclical relationship between negative emotions and drug addiction. Therefore, an introduction of a positive element, such as forgiveness, may help in alleviating negative feelings, thereby reducing the probability of drug use as a coping mechanism, and may further help in increasing their motivation to engage in treatment. Moreover, in addition to the positive effects of forgiveness on psychological and physical wellbeing as having been supported by previous research (Toussaint et al., 2016; Long et al., 2020), forgiveness is as well considered an effective element to cope with maltreatment experiences in the context of trauma (Freedman and Enright, 2017). Taken together, the literature supported the positive effect of forgiveness on one’s wellbeing, which is consistent with the present findings indicating its full mediating role in the association between childhood maltreatment and treatment motivation among drug addicts.
On the contrary, in view of earlier research that has identified deficits in self-efficacy as a potentially negative outcome of early maltreatment experiences (Sachs-Ericsson et al., 2011; Singer et al., 2016), this study sought to support a relationship between childhood maltreatment and self-efficacy. As a result, the negative association between the two constructs was found in the SEM analysis. Meanwhile, the significant association between self-efficacy and treatment motivation demonstrated that the efforts in this study to explore the mediating effect of self-efficacy between childhood maltreatment and treatment motivation were deemed successful. In other words, this finding indicated that negative experiences in childhood lowered the level of treatment motivation via a negative self-efficacy. Thus, consistent with previous studies, the results of this study suggested that childhood maltreatment experiences predict a low level of self-efficacy after decades.
Nevertheless, the indirect effect analysis showed that the association between self-efficacy and treatment motivation was statistically significant but not at the 0.001 level. Research has indicated that drug addicts with maltreatment histories reported a significantly higher number of lifetime addiction and treatment admission (Westermeyer et al., 2001; Khoury et al., 2010), which implies a high relapse rate after they were successfully recovered from addiction and were discharged from rehabilitation centers. Consequently, the high failure records to abstain from drug use might either negatively affect their sense of self-efficacy or strengthen their beliefs in their capacity to complete the treatment program and recover from addiction once again. Therefore, it seems reasonable to expect that some drug addicts involved in this sample have higher levels of self-efficacy. Furthermore, this sample reported high levels of self-efficacy on average (mean = 29.6) (Table 1), with the scale score ranging from a minimum of 10 to a maximum of 40, thereby causing a weaker effect for self-efficacy in this equation. Overall, the mediating results of this study suggested the critical role of forgiveness in drug treatment, while improving self-efficacy may be beneficial for drug addicts to abstain from drug use.
Limitations and Future Research
There were several methodological limitations to be considered when interpreting the results of this study. First, this sample was not ethnic and gender diverse. Previous research has indicated the gender, ethnic, and cultural differences in child maltreatment and its consequences (Lee et al., 2012; Asscher et al., 2015; Lansford et al., 2015). Moreover, several studies have pointed out the gender and cultural diversity in forgiveness (Toussaint and Webb, 2005; Paz et al., 2008) and self-efficacy (Klassen, 2004; Wang et al., 2019). However, the majority of respondents in this study were Malay males (96.4%), which may limit the findings to be generalized to a more diverse sample. Therefore, there is a need for future research to identify male and female samples of drug addicts from different ethnic groups that may be directly compared on the variables of various forms of childhood maltreatment and its effects on forgiveness, self-efficacy, and treatment motivation, which may thereby provide useful information regarding unique and common elements of treatment programs for drug-addicted male and female subjects.
Moreover, the study was conducted using a cross-sectional approach in which the data of childhood maltreatment, forgiveness, self-efficacy, and treatment motivation were collected at one point in time. However, several investigated variables are likely to fluctuate over time. For example, Gecas (1989) pointed out the dynamic nature of self-efficacy which may change over the life course depending on the immediate social context (Gecas, 1989). Moreover, previous research has demonstrated the relationship between active participation in addiction treatment programs with greater self-efficacy (Ilgen et al., 2005; McKellar et al., 2008). Thus, this might explain the average high levels of reported self-efficacy in this study, which might probably decrease after the completion of treatment. In addition, McCullough et al. (2003) also underlined the fluctuation of forgiveness over time (McCullough et al., 2003). Consequently, these instability factors limited the generalizability of the results. Thus, future research may focus on capturing fluctuations in these dynamic variables that might be related to treatment motivation and dropout in drug addicts by conducting a longitudinal study.
In addition, the respondents were asked to recall their maltreatment experiences that occurred before the age of 16 years (Bernstein et al., 2003). Their reports regarding the adverse experience that happened to them in childhood may have been influenced by their current health conditions and many years of illicit drug use after a long period of time, which thereby may complicate their memories regarding the effects of childhood maltreatment on their intention to use drug and motivation to abstain from drug use. Moreover, research has demonstrated that individuals who reported poor health conditions may have a bias to recall their childhood maltreatment experiences (Edwards et al., 2001; Sheikh, 2018). Therefore, future research may pay more attention to the factors that might aggravate the recall bias such as the length and duration of the questionnaire or bias explanations regarding the study’s objective in order to obtain a more precise estimate of the prevalence of childhood maltreatment histories.
Finally, lower socioeconomic status has consistently been shown to be associated with a higher risk of child maltreatment (Drake and Pandey, 1996; Lefebvre et al., 2017) mainly because of the stress and conflict that arise between children and parents due to economic pressures. Therefore, children from low-income families are more likely to be exposed to child abuse and neglect; meanwhile, poverty, which is usually followed by unemployment and insufficient level of education attainment, might increase stress and the likelihood of abuse drugs in adulthood. In short, all these confounding variables may influence the respondents’ motivation to abstain from drug use which might pose a threat to the research reliability and validity. Thus, future research should attempt to validate the findings of this study with comparative data from different socioeconomic groups of drug addicts.
Conclusion
Findings from this study highlighted the critical role of negative personal experiences developed early in life that appeared to carry over into adulthood and possibly incline the victims toward drug use to escape from painful memories or an attempt to reduce negative emotions associated with trauma, thereby negatively affecting their willingness to abstain from drug use or compromise their motivation in addiction treatment. Furthermore, the results demonstrated that forgiveness and self-efficacy played the role as protective factors to reduce the effects of childhood maltreatment experiences on treatment motivation. Moreover, the findings indicated that total scores of childhood maltreatment yielded similar results with different forms of maltreatment in relation to other investigated variables in this study, and supported and confirmed the co-occurrence across multiple types of maltreatment in an abusive family as has been found in earlier studies (Descartes et al., 2020). In addition, the mediating role of self-efficacy demonstrated that high self-efficacy may play a role in buffering the negative effects of childhood maltreatment on treatment motivation. Finally, forgiveness, by effectively reducing the negative emotions among drug addicts, may promote acceptance of self and further increase their motivation to engage in addiction treatment, thereby potentially preventing relapse. However, although forgiveness can be recommended as a mitigating element to assist individuals with a history of maltreatment, counselors or other professionals need to be careful when offering it. Recovery involving forgiveness is a difficult and long process, so avoid rushing to the outcomes and beware not to instill any kind of moral responsibility in victims to forgive their parents who have had hurt them.
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Author Contributions
LS: manuscript writing, data collection, and data analysis. MK: manuscript writing. RK, TT, and HA: data collection. All authors contributed to the article and approved the submitted version.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s Note
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Acknowledgments
We wish to thank Universiti Kebangsaan Malaysia for providing financial assistance in publishing this manuscript (publication grant: GP-2021-K021070).
Supplementary Material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.816373/full#supplementary-material
References
Ainsworth, M. S. (1989). Attachments beyond infancy. Am. Psychol. 44, 709–716. doi: 10.1037//0003-066x.44.4.709
Arslan, G. (2017). Psychological maltreatment, forgiveness, mindfulness, and internet addiction among young adults: a study of mediation effect. Comput. Hum. Behav. 72, 57–66. doi: 10.1016/j.chb.2017.02.037
Asscher, J. J., Van der Put, C. E., and Stams, G. J. J. M. (2015). Gender Differences in the Impact of Abuse and Neglect Victimization on Adolescent Offending Behavior. J. Fam. Viol. 30, 215–225. doi: 10.1007/s10896-014-9668-4
Awang, Z., Lim, S. H., and Zainudin, N. F. S. (2018). Pendekatan Mudah SEM- Structural Equation Modelling. Bandar Baru Bangi: MPWS Rich Resources.
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., and Fiore, M. C. (2004). Addiction Motivation Reformulated: an Affective Processing Model of Negative Reinforcement. Psychol. Rev. 111, 33–51. doi: 10.1037/0033-295X.111.1.33
Banducci, A. N., Hoffman, E. M., Lejuez, C. W., and Koenen, K. C. (2014). The impact of childhood abuse on inpatient substance users: specific links with risky sex, aggression, and emotion dysregulation. Child Abuse Negl. 38, 928–938. doi: 10.1016/j.chiabu.2013.12.007
Bandura, A. (1993). Perceived Self-Efficacy in Cognitive Development and Functioning. Educ. Psychol. 28, 117–148. doi: 10.1207/s15326985ep2802_3
Basu, A., McLaughlin, K. A., Misra, S., and Koenen, K. C. (2017). Childhood Maltreatment and Health Impact: the Examples of Cardiovascular Disease and Type 2 Diabetes Mellitus in Adults. Clin. Psychol. Sci. Pract. 24, 125–139. doi: 10.1111/cpsp.12191
Battjes, R. J., Gordon, M. S., O’Grady, K. E., Kinlock, T. W., and Carswell, M. A. (2003). Factors that predict adolescent motivation for substance abuse treatment. J. Subst. Abuse Treat. 24, 221–232. doi: 10.1016/S0740-5472(03)00022-9
Bennett, D. S., Sullivan, M. W., and Lewis, M. (2005). Young children’s adjustment as a function of maltreatment, shame, and anger. Child Maltreat. 10, 311–323. doi: 10.1177/1077559505278619
Bernstein, D. P., and Fink, L. (1998). Childhood Trauma Questionnaire : a Retrospective Self-report : Manual. United States: Harcourt Brace & Co.
Bernstein, D. P., Fink, L., Handelsman, L., Foote, J., Lovejoy, M., Wenzel, K., et al. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am. J. Psychiatry 151, 1132–1136. doi: 10.1176/ajp.151.8.1132
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., et al. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 27, 169–190. doi: 10.1016/S0145-2134(02)00541-0
Bikar, S. S., Rathakrishnan, B., Kamaluddin, M. R., Che Mohd Nasir, N., and Mohd Nasir, M. A. (2021). Social sustainability of post-disaster: how teachers enable primary school students to be resilient in times of Ranau earthquake. Sustainability 13:7308. doi: 10.3390/SU13137308
Blevins, C. E., Stephens, R. S., Walker, D. D., and Roffman, R. A. (2014). Situational determinants of use and treatment outcomes in marijuana dependent adults. Addict. Behav. 39, 546–552. doi: 10.1016/j.addbeh.2013.10.031
Burnette, J. L., Davis, D. E., Green, J. D., Worthington, E. L., and Bradfield, E. (2009). Insecure attachment and depressive symptoms: the mediating role of rumination, empathy, and forgiveness. Pers. Individ. Diff. 46, 276–280. doi: 10.1016/J.PAID.2008.10.016
Byrne, B. M. (2010). Structural Equation Modeling with AMOS: basic Concepts, Applications, and Programming. 2nd Edn. London: Routledge/Taylor & Francis Group.
Byrne, B. M. (2016). Structural Equation Modeling With AMOS. Structural Equation Modeling With AMOS. London: Routledge.
Chavarria, J., Stevens, E. B., Jason, L. A., and Ferrari, J. R. (2012). The effects of self-regulation and self-efficacy on substance use abstinence. Alcohol. Treatment Q. 30, 422–432. doi: 10.1080/07347324.2012.718960
Cieslak, R., Benight, C. C., and Caden Lehman, V. (2008). Coping self-efficacy mediates the effects of negative cognitions on posttraumatic distress. Behav. Res. Ther. 46, 788–798. doi: 10.1016/j.brat.2008.03.007
Currie, J., and Widom, C. S. (2010). Long-term consequences of child abuse and neglect on adult economic well-being. Child Maltreat. 15, 111–120. doi: 10.1177/1077559509355316
De Leon, G., Melnick, G., Kressel, D., and Jainchill, N. (1994). Circumstances, motivation, readiness, and suitability (the CMRS scales): predicting retention in therapeutic community treatment. Am. J. Drug Alcohol Abuse 20, 495–515. doi: 10.3109/00952999409109186
De Leon, G., Melnick, G., Thomas, G., Kressel, D., and Wexler, H. K. (2000). Motivation for treatment in a prison-based therapeutic community. Am. J. Drug Alcohol Abuse 26, 33–46. doi: 10.1081/ADA-100100589
Descartes, C. H., Maharaj, P. E., Quammie, M., Mills, J., Ramesar, M., and Pulwarty, H. (2020). It’s Never One Type: the Co-Occurrence of Child Abuse and Neglect among Children Living in Community Residences in Trinidad. J. Child Adolesc. Trauma 13, 419–427. doi: 10.1007/s40653-019-00293-x
Dhamayanti, M., Noviandhari, A., Masdiani, N., Pandia, V., and Sekarwana, N. (2020). The association of depression with child abuse among Indonesian adolescents. BMC Pediatr. 20:313. doi: 10.1186/S12887-020-02218-2/TABLES/4
Drake, B., and Pandey, S. (1996). Understanding the relationship between neighborhood poverty and specific types of child maltreatment. Child Abuse Negl. 20, 1003–1018. doi: 10.1016/0145-2134(96)00091-9
Edwards, V. J., Anda, R. F., Nordenberg, D. F., Felitti, V. J., Williamson, D. F., and Wright, J. A. (2001). Bias assessment for child abuse survey: factors affecting probability of response to a survey about childhood abuse. Child Abuse Negl. 25, 307–312. doi: 10.1016/S0145-2134(00)00238-6
Elwyn, L., and Smith, C. (2013). Child Maltreatment and Adult Substance Abuse: the Role of Memory. J. Soc. Work Pract. Addict. 13, 269–294. doi: 10.1080/1533256X.2013.814483
Enright, R. D. (1996). Counseling Within the Forgiveness Triad: on Forgiving, Receiving Forgiveness, and Self-Forgiveness. Counsel. Values 40, 107–126. doi: 10.1002/j.2161-007X.1996.tb00844.x
Fornell, C., and Larcker, D. F. (1981). Evaluating Structural Equation Models with Unobservable Variables and Measurement Error. J. Market. Res. 18:39.
Freedman, S., and Enright, R. D. (2017). The Use of Forgiveness Therapy with Female Survivors of Abuse. J. Womens Health Care 6:3. doi: 10.4172/2167-0420.1000369
Funk, R. R., McDermeit, M., Godley, S. H., and Adams, L. (2003). Maltreatment Issues by Level of Adolescent Substance Abuse Treatment: the Extent of the Problem at Intake and Relationship to Early Outcomes. Child Maltreat. 8, 36–45. doi: 10.1177/1077559502239607
Gerdner, A., and Allgulander, C. (2009). Psychometric properties of the Swedish version of the Childhood Trauma Questionnaire - Short Form (CTQ-SF). Nordic J. Psychiatry 63, 160–170. doi: 10.1080/08039480802514366
Grella, C. E., and Joshi, V. (2003). Treatment Processes and Outcomes Among Adolescents With a History of Abuse Who Are in Drug Treatment. Child Maltreat. 8, 7–18. doi: 10.1177/1077559502239610
Guloglu, B., Karairmak, O., and Emiral, E. (2016). The role of spirituality and forgiveness in childhood trauma. Anatol. J. Psychiatry 17:309. doi: 10.5455/apd.217593
Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., and Tatham, R. L. (2006). Multivariate Data Analysis. 6th Edn. United States: Pearson Prentice Hall.
Ilgen, M., McKellar, J., and Tiet, Q. (2005). Abstinence self-efficacy and abstinence 1 year after substance use disorder treatment. J. Consult. Clin. Psychol. 73, 1175–1180. doi: 10.1037/0022-006X.73.6.1175
Infurna, M. R., Reichl, C., Parzer, P., Schimmenti, A., Bifulco, A., and Kaess, M. (2016). Associations between depression and specific childhood experiences of abuse and neglect: a meta-analysis. J. Affect. Disord. 190, 47–55. doi: 10.1016/J.JAD.2015.09.006
Kadden, R. M., and Litt, M. D. (2011). The role of self-efficacy in the treatment of substance use disorders. Addict. Behav. 36, 1120–6. doi: 10.1016/j.addbeh.2011.07.032
Kelly, J. D. (2018). Forgiveness: a Key Resiliency Builder. Clinical Orthopaedics and Related Research. United States: Lippincott Williams and Wilkins. doi: 10.1007/s11999.0000000000000024
Kelly, J. F., and Greene, M. C. (2014). Where there’s a will there’s a way: a longitudinal investigation of the interplay between recovery motivation and self-efficacy in predicting treatment outcome. Psychol. Addict. Behav. 28, 928–934. doi: 10.1037/a0034727
Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., and Ressler, K. J. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depress. Anxiety 27, 1077–1086. doi: 10.1002/da.20751
Kim, E. Y., Park, J., and Kim, B. (2016). Type of childhood maltreatment and the risk of criminal recidivism in adult probationers: a cross-sectional study. BMC Psychiatry 16:294. doi: 10.1186/S12888-016-1001-8
Kim, J., and Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. J. Child Psychol. Psychiatry All. Discipl. 51, 706–716. doi: 10.1111/j.1469-7610.2009.02202.x
Klassen, R. M. (2004). Optimism and Realism: a Review of Self-efficacy from a Cross-cultural Perspective. Int. J. Psychol. 39, 205–230. doi: 10.1080/00207590344000330
Lamis, D. A., Wilson, C. K., King, N. M., and Kaslow, N. J. (2014). Child Abuse, Social Support, and Social Functioning in African American Children. J. Fam. Viol. 29, 881–891. doi: 10.1007/s10896-014-9639-9
Lansford, J. E., Godwin, J., Tirado, L. M. U., Zelli, A., Al-Hassan, S. M., Bacchini, D., et al. (2015). Individual, family, and culture level contributions to child physical abuse and neglect: a longitudinal study in nine countries. Dev. Psychopathol. 27, 1417–1428. doi: 10.1017/S095457941500084X
Lee, C., Cronley, C., White, H. R., Mun, E. Y., Stouthamer-Loeber, M., and Loeber, R. (2012). Racial differences in the consequences of childhood maltreatment for adolescent and young adult depression, heavy drinking, and violence. J. Adolesc. Health 50, 443–449. doi: 10.1016/j.jadohealth.2011.09.014
Lefebvre, R., Fallon, B., Wert, M., and Van Filippelli, J. (2017). Examining the Relationship between Economic Hardship and Child Maltreatment Using Data from the Ontario Incidence Study of Reported Child Abuse and Neglect-2013 (OIS-2013). Behav. Sci. 7:6. doi: 10.3390/BS7010006
Lin, W.-F., Mack, D., Enright, R. D., Krahn, D., and Baskin, T. W. (2004). Effects of Forgiveness Therapy on Anger, Mood, and Vulnerability to Substance Use Among Inpatient Substance-Dependent Clients. J. Consult. Clin. Psychol. 72, 1114–1121. doi: 10.1037/0022-006X.72.6.1114
Lim, Y. Y., Wahab, S., Kumar, J., Ibrahim, F., and Kamaluddin, M. R. (2021). Typologies and psychological profiles of child sexual abusers: an extensive review. Children 8:333. doi: 10.3390/CHILDREN8050333
Lippard, E. T. C., and Nemeroff, C. B. (2020). The devastating clinical consequences of child abuse and neglect: increased disease vulnerability and poor treatment response in mood disorders. Am. J. of Psychiatry 177, 20–36. doi: 10.1176/appi.ajp.2019.19010020
Litt, M. D., Kadden, R. M., Kabela-Cormier, E., and Petry, N. M. (2008). Coping skills training and contingency management treatments for marijuana dependence: exploring mechanisms of behavior change. Addiction 103, 638–648. doi: 10.1111/j.1360-0443.2008.02137.x
Long, K. N. G., Worthington, E. L., VanderWeele, T. J., and Chen, Y. (2020). Forgiveness of others and subsequent health and well-being in mid-life: a longitudinal study on female nurses. BMC Psychol. 8:104. doi: 10.1186/s40359-020-00470-w
Loy, S. M., Khairudin, R., Muda, T. E. A. T., Mokhtar, D. M., and Kamaluddin, M. R. (2020a). Survey dataset on the prevalence of childhood maltreatment history among drug addicts in Malaysia. Data Brief 31:105864. doi: 10.1016/J.DIB.2020.105864
Loy, S. M., Mohammad, R. K., Rozainee, K., Tengku, E. A., Tengku, M., Noremy, M. A., et al. (2020b). Factor structure and Reliability of the Malay version of the Childhood Trauma Questionnaire-Short Form (M-CTQ-SF) among drug addicts in Malaysia. Int. J. Psychosoc. Rehabil. 24, 4462–4475. doi: 10.37200/ijpr/v24i4/pr201549
Lu, F. Y., Wen, S., Deng, G., and Tang, Y. L. (2017). Self-concept mediate the relationship between childhood maltreatment and abstinence motivation as well as self-efficacy among drug addicts. Addict. Behav. 68, 52–58. doi: 10.1016/j.addbeh.2017.01.017
Luszczynska, A., Scholz, U., and Schwarzer, R. (2005). The general self-efficacy scale: multicultural validation studies. J. Psychol. Interdiscipl. Appl. 139, 439–457. doi: 10.3200/JRLP.139.5.439-457
Mainali, P., Rai, T., and Rutkofsky, I. H. (2020). From Child Abuse to Developing Borderline Personality Disorder Into Adulthood: exploring the Neuromorphological and Epigenetic Pathway. Cureus 12:e9474. doi: 10.7759/CUREUS.9474
Majer, J. M., Chapman, H. M., and Jason, L. A. (2016). Abstinence Self-Efficacy and Substance Use at 2 Years: the Moderating Effects of Residential Treatment Conditions. Alcohol. Treatment Q. 34, 386–401. doi: 10.1080/07347324.2016.1217708
Majer, J. M., Olson, B. D., Komer, A. C., and Jason, L. A. (2015). Motivation Among Exoffenders Exiting Treatment: the Role of Abstinence Self-Efficacy. J. Offend. Rehabil. 54, 161–174. doi: 10.1080/10509674.2015.1023483
Mandavia, A., Robinson, G. G. N., Bradley, B., Ressler, K. J., and Powers, A. (2016). Exposure to Childhood Abuse and Later Substance Use: indirect Effects of Emotion Dysregulation and Exposure to Trauma. J. Traumat. Stress 29, 422–429. doi: 10.1002/jts.22131
Maynard, C., Piferi, R. L., and Jobe, R. L. (2016). Role of Supportive Others in the Forgiveness Process. Counsel. Values 61, 28–43. doi: 10.1002/cvj.12024
McCullough, M. E., Fincham, F. D., and Tsang, J.-A. (2003). Forgiveness, forbearance, and time: the temporal unfolding of transgression-related interpersonal motivations. J. Pers. Soc. Psychol. 84, 540–557. doi: 10.1037//0022-3514.84.3.540
McCullough, M. E., Rachal, K. C., Sandage, S. J., Worthington, E. L., Brown, S. W., and Hight, T. L. (1998). Interpersonal forgiving in close relationships: II. Theoretical elaboration and measurement. J. Pers. Soc. Psychol. 75, 1586–1603. doi: 10.1037/0022-3514.75.6.1586
McGaffin, B. J., Lyons, G. C. B., and Deane, F. P. (2013). Self-Forgiveness, Shame, and Guilt in Recovery from Drug and Alcohol Problems. Substance Abuse 34, 396–404. doi: 10.1080/08897077.2013.781564
McKay, J. R. (2011). Negative mood, craving, and alcohol relapse: can treatment interrupt the process? Curr. Psychiatry Rep. 13, 431–433. doi: 10.1007/s11920-011-0225-z
McKay, J. R., Foltz, C., Leahy, P., Stephens, R., Orwin, R. G., and Crowley, E. M. (2004). Step down continuing care in the treatment of substance abuse: correlates of participation and outcome effects. Eval. Program Plan. 27, 321–331. doi: 10.1016/j.evalprogplan.2004.04.005
McKellar, J., Ilgen, M., Moos, B. S., and Moos, R. (2008). Predictors of changes in alcohol-related self-efficacy over 16 years. J. Subst. Abuse Treat. 35, 148–155. doi: 10.1016/j.jsat.2007.09.003
McLaughlin, K. A., Koenen, K. C., Bromet, E. J., Karam, E. G., Liu, H., Petukhova, M., et al. (2017). Childhood adversities and post-traumatic stress disorder: evidence for stress sensitisation in the World Mental Health Surveys. Br. J. Psychiatry 211:280. doi: 10.1192/BJP.BP.116.197640
McNeish, D. (2017). Exploratory Factor Analysis With Small Samples and Missing Data. J. Pers. Assess. 99, 637–652. doi: 10.1080/00223891.2016.1252382
Melnick, G., Hawke, J., and De Leon, G. (2014). Motivation and readiness for drug treatment: differences by modality and special populations. J. Addict. Dis. 33, 134–147. doi: 10.1080/10550887.2014.909700
Milojevich, H. M., Levine, L. J., Cathcart, E. J., and Quas, J. A. (2018). The role of maltreatment in the development of coping strategies. J. Appl. Dev. Psychol. 54, 23–32. doi: 10.1016/j.appdev.2017.10.005
Minh, A., Matheson, F. I., Daoud, N., Hamilton-Wright, S., Pedersen, C., Borenstein, H., et al. (2013). Linking Childhood and Adult Criminality: using a Life Course Framework to Examine Childhood Abuse and Neglect, Substance Use and Adult Partner Violence. Int. J. Environ. Res. Public Health 10:5470. doi: 10.3390/IJERPH10115470
Müller, L. E., Bertsch, K., Bülau, K., Herpertz, S. C., and Buchheim, A. (2019). Emotional neglect in childhood shapes social dysfunctioning in adults by influencing the oxytocin and the attachment system: results from a population-based study. Int. J. Psychophysiol. 136, 73–80. doi: 10.1016/j.ijpsycho.2018.05.011
Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., and Vos, T. (2012). The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: a Systematic Review and Meta-Analysis. PLoS Med. 9:e1001349. doi: 10.1371/journal.pmed.1001349
O’Connor, L. E., Berry, J. W., Inaba, D., Weiss, J., and Morrison, A. (1994). Shame, guilt, and depression in men and women in recovery from addiction. J. Subst. Abuse Treat. 11, 503–510. doi: 10.1016/0740-5472(94)90001-9
Paz, R., Neto, F., and Mullet, E. (2008). Forgiveness: a China-Western Europe comparison. J. Psychol. Interdiscipl. Appl. 142, 147–158. doi: 10.3200/JRLP.142.2.147-158
Pears, K., and Fisher, P. A. (2005). Developmental, cognitive, and neuropsychological functioning in preschool-aged foster children: associations with prior maltreatment and placement history. J. Dev. Behav. Pediatr. 26, 112–122. doi: 10.1097/00004703-200504000-00006
Rahim, M., and Patton, R. (2015). The association between shame and substance use in young people: a systematic review. PeerJ. 3:e737. doi: 10.7717/peerj.737
Raj, P., Elizabeth, C. S., and Padmakumari, P. (2016). Mental health through forgiveness: exploring the roots and benefits. Cogent Psychol. 3:1153817. doi: 10.1080/23311908.2016.1153817
Ricciardi, E., Rota, G., Sani, L., Gentili, C., Gaglianese, A., Guazzelli, M., et al. (2013). How the brain heals emotional wounds: the functional neuroanatomy of forgiveness. Front. Hum. Neurosci. 7:839. doi: 10.3389/fnhum.2013.00839
Riggs, S. A. (2010). Childhood emotional abuse and the attachment system across the life cycle: what theory and research tell us. J. Aggr. Maltreat. Trauma 19, 5–51. doi: 10.1080/10926770903475968
Rosenkranz, S. E., Henderson, J. L., Muller, R. T., and Goodman, I. R. (2012). Motivation and maltreatment history among youth entering substance abuse treatment. Psychol. Addict. Behav. 26, 171–177. doi: 10.1037/a0023800
Rutter, M. (2007). Resilience, competence, and coping. Child Abuse Negl. 31, 205–209. doi: 10.1016/j.chiabu.2007.02.001
Sachs-Ericsson, N., Medley, A. N., Kendall-Tackett, K., and Taylor, J. (2011). Childhood abuse and current health problems among older adults: the mediating role of self-efficacy. Psychol. Viol. 1, 106–120. doi: 10.1037/a0023139
Sacks, J. A. Y., McKendrick, K., and Banks, S. (2008). The impact of early trauma and abuse on residential substance abuse treatment outcomes for women. J. Subst. Abuse Treat. 34, 90–100. doi: 10.1016/j.jsat.2007.01.010
Scherer, M., Worthington, E. L., Hook, J. N., and Campana, K. L. (2011). Forgiveness and the Bottle: promoting Self-Forgiveness in Individuals Who Abuse Alcohol. J. Addict. Dis. 30, 382–395. doi: 10.1080/10550887.2011.609804
Schuck, A. M., and Widom, C. S. (2019). Posttraumatic Stress Disorder in Maltreated Children Grown Up: the Influence of Neighborhood. J. Traumat. Stress 32:78. doi: 10.1002/JTS.22355
Schwarzer, R., and Jerusalem, M. (1995). Generalized self - efficacy scale. Measures in health psychology: a user’s portfolio. Causal Control Beliefs 1, 35–37. doi: 10.1097/PHM.0b013e318230fb68
Schwarzer, R., Bäßler, J., Kwiatek, P., Schröder, K., and Zhang, J. X. (1997). The assessment of optimistic self-beliefs: comparison of the German, Spanish, and Chinese versions of the general self-efficacy scale. Appl. Psychol. 46, 69–88. doi: 10.1111/j.1464-0597.1997.tb01096.x
Serafini, K., Toohey, M. J., Kiluk, B. D., and Carroll, K. M. (2016). Anger and Its Association with Substance Use Treatment Outcomes in a Sample of Adolescents. J. Child Adolesc. Subst. Abuse 25, 391–398. doi: 10.1080/1067828X.2015.1049394
Sheikh, M. A. (2018). Childhood adversities and chronic conditions: examination of mediators, recall bias and age at diagnosis. Int. J. Public Health 63, 181–192. doi: 10.1007/s00038-017-1021-2
Simpson, T. L., and Miller, W. R. (2002). Concomitance between childhood sexual and physical abuse and substance use problems. A review. Clin. Psychol. Rev. 22, 27–77. doi: 10.1016/s0272-7358(00)00088-x
Singer, M. J., Humphreys, K. L., and Lee, S. S. (2016). Coping Self-Efficacy Mediates the Association Between Child Abuse and ADHD in Adulthood. J. Attent. Disord. 20, 695–703. doi: 10.1177/1087054712465337
Snyder, C. R., and Heinze, L. S. (2005). Forgiveness as a mediator of the relationship between PTSD and hostility in survivors of childhood abuse. Cogn. Emot. 19, 413–431. doi: 10.1080/02699930441000175
Srivastava, K. (2011). Positive mental health and its relationship with resilience. Industr. Psychiatry J. 20:75. doi: 10.4103/0972-6748.102469
Taylor, J., Bradbury-Jones, C., Lazenbatt, A., and Soliman, F. (2016). Child maltreatment: pathway to chronic and long-term conditions? J. Public Health 38, 426–431. doi: 10.1093/pubmed/fdv117
Tharshini, N. K., Ibrahim, F., Kamaluddin, M. R., Rathakrishnan, B., and Che Mohd Nasir, N. (2021). The link between individual personality traits and criminality: a systematic review. Int. J. Environ. Res. Public Health 18:8663. doi: 10.3390/IJERPH18168663
Thompson, L. Y., Snyder, C. R., Hoffman, L., Michael, S. T., Rasmussen, H. N., Billings, L. S., et al. (2005). Dispositional Forgiveness of Self, Others, and Situations. J. Pers. 73, 313–360. doi: 10.1111/j.1467-6494.2005.00311.x
Toussaint, L. L., Shields, G. S., and Slavich, G. M. (2016). Forgiveness, Stress, and Health: a 5-Week Dynamic Parallel Process Study. Ann. Behav. Med. 50, 727–735. doi: 10.1007/s12160-016-9796-6
Toussaint, L., and Webb, J. R. (2005). Gender differences in the relationship between empathy and forgiveness. J. Soc. Psychol. 145, 673–685. doi: 10.3200/SOCP.145.6.673-686
Tsang, S. K. M., Hui, E. K. P., and Law, B. C. M. (2012). Self-efficacy as a positive youth development construct: a conceptual review. Sci. World J. 2012:452327. doi: 10.1100/2012/452327
Wahab, S., Baharom, M. A., Abd Rahman, F. N., Wahab, K. A., Zulkifly, M. A., Azmi, A. D., et al. (2021). The relationship of lifetime substance-use disorder with family functioning, childhood victimisation, and depression, among juvenile offenders in Malaysia. Addict. Behav. Rep. 14:100359. doi: 10.1016/J.ABREP.2021.100359
Wang, Y., Xu, L., Qin, W., Zhang, J., Xia, Y., Jing, X., et al. (2019). Gender difference in general self-efficacy among young-old elderly aged 60–74 in rural shandong China: a cross-sectional survey. Int. J. Environ. Res. Public Health 16:5070. doi: 10.3390/ijerph16245070
Webb, J. R., Robinson, E. A. R., Brower, K. J., and Zucker, R. A. (2006). Forgiveness and alcohol problems among people entering substance abuse treatment. J. Addict. Dis. 25, 55–67. doi: 10.1300/J069v25n03_08
Westermeyer, J., Wahmanholm, K., and Thuras, P. (2001). Effects of childhood physical abuse on course and severity of substance abuse. Am. J. Addict. 10, 101–110. doi: 10.1080/105504901750227769
Witvliet, C. V. O., and McCullough, M. E. (2007). “Forgiveness and Health: a Review and Theoretical Exploration of Emotion Pathways” in Altruism and Health: perspectives from Empirical Research. Ed S. G. Post. (Oxford: Oxford University Press). doi: 10.1093/acprof:oso/9780195182910.003.0017
Worthington, E. L., Griffin, B. J., Toussaint, L. L., Nonterah, C. W., Utsey, S. O., and Garthe, R. C. (2016). Forgiveness as a Catalyst for Psychological, Physical, and Spiritual Resilience in Disasters and Crises. J. Psychol. Theol. 44, 152–165.
Worthington, E. L., Scherer, M., and Cooke, K. L. (2006). Forgiveness in the treatment of persons with alcohol problems. Alcohol. Treatment Q. 24, 125–145. doi: 10.1300/J020v24n01_08
Keywords: forgiveness, self-efficacy, childhood maltreatment, treatment motivation, drug addicts
Citation: See Mey L, Khairudin R, Tengku Muda TEA, Abdullah @ Mohd Nor H and Kamaluddin MR (2022) The Mediating Role of Forgiveness and Self-Efficacy in the Relationship Between Childhood Maltreatment and Treatment Motivation Among Malaysian Male Drug Addicts. Front. Psychol. 13:816373. doi: 10.3389/fpsyg.2022.816373
Received: 16 November 2021; Accepted: 14 February 2022;
Published: 11 March 2022.
Edited by:
Naixue Cui, Shandong University, ChinaReviewed by:
Dawid Konrad Scigala, The Maria Grzegorzewska University, PolandNatalia Bueso-Izquierdo, University of Extremadura, Spain
Copyright © 2022 See Mey, Khairudin, Tengku Muda, Abdullah @ Mohd Nor and Kamaluddin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Mohammad Rahim Kamaluddin, rahimk@ukm.edu.my